Every hospital organization is unique and has attributes
that separates them from others, these can include: number of beds, programs
and services, budgets, patient population served, models of care and staffing
models. However, there are many similarities – there never seems to be enough
beds and inevitably patients have to wait for services, whether they be
internal services or those provided by your community partners. Patient flow
and patient throughput is a major focus in all hospitals. The question remains,
how do we measure patient flow and what is the gold standard or benchmark for
excellent patient flow?
Due to the uniqueness of each organization, there is no one
metric or statement that can be set for all hospitals. The targets will continue
to evolve and new goals should always be reached for. The key is to start measuring and continue to
strive for better.
IDENTIFYING OPPORTUNITIES FOR PROCESS IMPROVEMENT
How do you know where to focus your efforts?
That’s where Medworxx can help. Like
the old adage says, you can’t manage what you can’t measure. Medworxx data is already doing the
measuring—you just need to start looking at the data and creating the internal
benchmarks for your unique organization. Monitoring data to identify where
process improvement efforts should be focused can include:
Admission day practices – are we admitting the right
patients? Medworxx data on Avoidable Admissions will give you the insight into
the data to understand who is being admitted and if those patients are
appropriate for that level of care
Discharge practices – are we discharging or transitioning
patients as soon as they are clinically stable? Medworxx RFD/T data will
provide organizations with the number and percent of potential avoidable days,
often referred to as the ‘low hanging fruit’.
Even a small reduction in avoidable days can result in aiding
significantly in daily bed flow challenges.
Focus on organizational (internal) barriers - Anecdotal
information can help guide organizations to areas in need of process redesign.
Are there clear referral processes to multidisciplinary team members and are
diagnostic tests being ordered early enough in the stay of the patient?
TRENDS FROM PATIENT THROUGHPUT REVIEWS
Through the work Medworxx has completed in the past year
conducting Patient Throughput Reviews (PTR), we have documented the following
patient flow trends in Admission Day Practices, Discharge Practices and
Admission Day Practices
Potential avoidable admissions ranged from 10-19% with an
average of 13%
This number represents all patients that did not meet the clinical criteria for
admission. What does this mean for an organization? Those patients occupied a
bed but did not require that specific level of care. This prevents other
patients that do meet clinical criteria for admission to come into hospital and
obtain the required treatments and services. This creates bottlenecks and
backlogs in all areas of the hospital.
Organizations that measure and create strategies to reduce avoidable
admissions will have a positive return on patient flow and throughput.
RFD/T days ranged from 23% to 35% with an average of 31.5%
This represents the patients that were clinically stable but remained in
hospital due to barriers, interruptions or delays in their care. Potential avoidable days is an important
metric to measure as these are days that could have been saved and beds turned
over for other patients that would clinically require the bed. Reducing these numbers is vital to creating
capacity and flow in your organization. It also leads to greater patient and
Waiting for allied health assessments/treatments, medication
treatments such as IV antibiotics and diagnostic testing orders/delays, are the
most commonly documented reasons patients remain in hospital after they have
been deemed clinically stable.
Understanding the precipitating factors that contribute to these delays is
important. Data can help determine:
When are these delays occurring? Time of day or
day of the week, could the issue be related to weekend or off hour coverage
At what point in the patient journey are these
Are tests and services being ordered late in the
admission or could these services be provided on an out-patient basis?
Objective data enables your hospital to create strategies
for improvement. So remember, start small but think big and before you know it
your organization will look back on your journey with a true feeling of
accomplishment and the knowledge that slow and steady always ensures successful
OPTIMIZING PATIENT FLOW
Benchmarking is key. Begin by getting a baseline to
jumpstart your measurements. Start small and ask questions. Develop a culture
of continued improvement throughout your organization by:
Engaging and communicating with staff
Developing a plan - start with something attainable and
create a plan that strives to keep the finger on the pulse
Revisiting your data on a regular basis
Setting new benchmarks and goals monthly, quarterly, and
These are just a few strategies that will get your
started. Medworxx is committed to
helping your organization realize its potential. Please reach out to a member of our team as
we are excited to help you develop the plan that works best for your
Remaining in the hospital
when a patient no longer requires an acute care setting puts them at risk for
many reasons: nosocomial infections, physical deconditioning, and decreased
mental status are some key examples. The longer the Length of Stay (LOS)
exacerbates these and results in poor clinical outcomes and dissatisfied
patients and families. In hospitals we, the care providers, are overwhelmed and are often task
focused, which prohibits us from not focusing on progression of care. We need to be go back to basics and put the
focus back on the patient and providing quality care.
Clinicians and Care Providers
Engage Earlier - start engaging the patient and the family about their goals of care on the day of admission.
Make Care Coordination Patient Focused in Real Time - assign a target Estimated Date of Discharge (EDD)
on the day of admission and continue to review it daily as the patients
progress through their care journey to discharge. Discharge can be to their home
or transition to an alternate care setting.
Be Proactive - discharge planning must be
proactive not reactive.
Identify Barriers and Delays on a Daily Basis - focus on patient flow daily to identify any
barriers, delays or interruptions in the patient journey. These barriers should be identified and acted
upon daily in real time to ensure the patient is receiving the best care, the
right level of care and having progress in their care path daily. Keeping patients involved in their daily care
and hospital LOS goals with improved communication and collaboration puts the
patient first and will improve patient satisfaction.
Standardize Processes - hospitals need to standardize their patient flow
processes, make them visible, and communicate across the organization.
Encourage Collaboration - embrace a culture where
every member of the Multidisciplinary team is involved in the care plan of the
patient which includes the discharge plan.
Although many hospitals now have discharge planners, social workers, patient
flow coordinators to facilitate discharge plans, it is still the responsibility
of all members of the care team.
Care delivered must be a value-add to the patient. We do not want our patients sitting around wondering what is happening with their plan of care. Communication is key among the care delivery team and, more importantly, with the patient and their family.
We have all heard the phrase "happy wife, happy life." For clinicians out there, "happy patient, happy nurse."
Both of the NHS England initiatives (Clinical Utilisation Review and SAFER) cite evidence that patients deteriorate physically and cognitively in direct proportion to their length of stay; and for elderly patients this has a significant impact on life-expectancy. Their common goal is to minimise inappropriate delays to ensure Safe, Rapid Discharge or Transition of Patients and to avoid unnecessary hospital stays at an inappropriate level of care.
In this whitepaper, Peter Ellis, Managing Director Medworxx UK, discusses how both Clinical Utilisation Review (CUR) and SAFER (RED2GREEN days) intend to provide transparency and rigour to managing the patient's journey to ensure, at a minimum, daily assessment of key activities and status. These initiatives are interdependent and if appropriately integrated and harnessed, provide a comprehensive picture of the appropriateness of days of care across the organisation.
Big Data, aka the biggest challenge facing organizations everywhere, isn’t going away anytime soon. According to IBM, every day we create 2.5 quintillion bytes of data. To give you an idea of what that may look like, one terabyte alone is the equivalent of 4.5 million books — overwhelming to think about, especially for healthcare providers.
From medical charts and prescriptions to financial and insurance information, patients generate a lot of data throughout their lifetimes. Some of that data is structured. However, even within sophisticated healthcare organizations, most of it — paper documents, ad hoc emails, data created through monitoring devices, for example — is not. As healthcare moves toward more of an evidence based model, data will play more of an instrumental role. Now more than ever, it’s important for healthcare providers to realize organizational success has less to do with how much data they gather and more to do with how data is utilized.
Planning Makes Perfect To improve patient outcomes, healthcare providers must plan appropriately and develop a comprehensive strategy for gathering and utilizing data. For starters, everyone — including the care team and senior executives — should reflect on how they would respond to the following questions regarding data management:
Who within the organization owns data management?
Who else needs to be involved?
How is data gathered?
Where is the data going once it’s gathered?
What does the data actually mean?
How is the data being used to enhance the patient experience?